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Struggle to overcome childhood cancer leaves its mark years later
By Anjali Athavaley | Wall Street Journal
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Published: 12/16/2007 10:38 PM

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Andrew Flaton survived a brain tumor as a child, but he still suffers from the effects of his cancer treatments. One of his most challenging tasks: holding down a job.

He was left almost entirely deaf after undergoing chemotherapy. He can't work more than four hours a day without feeling exhausted, and he often suffers from panic attacks, which he struggles to keep under control.

The 25-year-old Oakville, Mo., resident earns less than $700 a month and lives with his grandparents, and the longest period he has spent in one job -- doing part-time filing work for an anesthesiologist -- is two years.

Before landing his current job as a retail clerk, Flaton was unemployed for a year. He filled out close to two dozen job applications without receiving any calls for an interview. "It was very difficult to find an employer who was accepting of what I could and could not do," he says.

As Flaton's struggle illustrates, the transition into the workplace can be rocky for many childhood-cancer survivors -- especially those who have been treated with high doses of radiation and chemotherapy. The resulting cognitive and physical impairments can make it hard to keep a job. And while workers who contract cancer or a chronic illness as adults carry similar impairments, childhood survivors face the added obstacle of trying to get and keep that all-important first job -- for many people the first chance to get employer-provided health insurance -- and establish a career.

The problem is becoming more acute as a greater number of childhood-cancer survivors enter the workforce, thanks to improvements in treatments over the past few decades. For patients age 14 and younger who were diagnosed between 1975 and 1977, 58 percent survived at least five years, according to the National Cancer Institute. For those diagnosed between 1996 and 2003, the rate jumped to 80 percent.

Though no one tracks the number of survivors in the workforce, doctors and agencies who deal with childhood cancer patients say it is increasing.

Survivors of pediatric cancer "are competing with young, enthusiastic, healthy, hard-working people," says Robert Hayashi, co-founder of the Late Effects Clinic at St. Louis Children's Hospital. "They are often at a disadvantage when they are being considered for entry-level positions."

According to a study published in June in the journal Pediatric Blood and Cancer, 5.6 percent of cancer survivors have never been employed, compared with 1.2 percent of their siblings.

"We were surprised at the magnitude of the difference," says Debra Friedman, an author of the study and director of the Survivorship Program at the Fred Hutchinson Cancer Research Center in Seattle. The research was based on self-reported employment history in 9,736 childhood-cancer survivors and 3,065 siblings over age 18 between 1994 and 1999.

The risk of having never been employed was highest among survivors of brain tumors and bone cancers, who typically go through the most severe treatments, which include high doses of radiation and sometimes even amputation. But the risk of chronic health problems resulting in employment problems was spread across various types of cancer, says Friedman, who is also an associate professor of pediatrics at the University of Washington in Seattle.

The risk of unemployment was higher if patients were diagnosed at a younger age, presumably because the consequences of treatment are more severe.

In many cases, childhood-cancer survivors are protected from employment discrimination by the federal Americans with Disabilities Act. Employers must make accommodations for people who have a disability where there is some kind of workplace barrier that needs to be removed, such as allowing time off for medical treatments or ensuring that workplace buildings are accessible to employees with physical impairments, says Peggy Mastroianni, associate legal counsel at the U.S. Equal Employment Opportunity Commission.

But the ADA applies to employers only with 15 or more employees.

Companies can't legally ask a job applicant's medical history, but they may ask questions related to ability. Federal law prohibits employers that offer group health-insurance plans from denying employees coverage based on health status.

Clinics that specialize in treating adult survivors of childhood cancers encourage their patients to find positions at larger employers, which are more likely than small businesses to offer group health plans.

The range of difficulties that childhood survivors face in adulthood varies, depending on diagnosis and treatment, says Friedman. Brain-tumor survivors who have gone through cranial radiation and chemotherapy treatments, for instance, may experience developmental and cognitive issues ranging from mild attention-span difficulties to profound learning disabilities.

Survivors of leukemia can be at risk for obesity, diabetes and high blood pressure, which could result in cardiovascular disease, and some chemotherapy drugs used to treat bone cancer may cause heart problems.